Book reviews

Principles and Practice of Renal Nursing edited by Paul

Challinor and John Sedgewick. 1998. Stanley Thornes Publishers

Ltd. ISBN 0748733310. Pp. 310. Price 25.

This is an essential text for renal nursing courses, and should be in

every renal unit's book-case. It may, however, be a bit daunting for

pre-registration nursing students.

The rst three chapters give an introduction to nephrology

nursing and renal physiology in a form that would be readable and

interesting to renal and non-renal trained nurses. The remaining

chapters offer a fairly detailed approach to the psychosocial aspects

of renal failure and the technicalities of renal replacement therapy.

Most topics are covered in a satisfying amount of detail, although

the ethics of the withdrawal of treatment, or the decision not to

treat, is mentioned very briey. With the present climate of

rationing healthcare, this is perhaps worthy of more discussion.

In the nal chapter, on renal failure in childhood and adolescence,

it has only been possible to describe the most essential psycholog-

ical, developmental and physical differences between the care of

children and the care of adults with renal failure. However, this is

probably sufcient as the majority of renal nurses care for adults.

It is exciting to nd a book on nursing care so well referenced and

evidence-based, written by professionals with extensive practical

experience.

The chapters are clearly written and well planned, beginning with

learning objectives and ending with a conclusion and review

questions. Useful practical information is summarized in the

margins. Case studies are used to illustrate the practical application

of theoretical aspects and help the reader to relate the text to real-

life situations. Patient education is an essential part of renal nursing

and this aspect is accentuated throughout the text.

In renal replacement therapy, it may be easy to become carried

away with the technical aspects of the equipment, and lose sight of

the patient with renal failure as a real, whole person. The editors

and contributors have managed to accentuate the holistic care of the

person with renal failure, and still provide important technical

information.

In conclusion, this is an excellent book for nurses working in the

eld of renal care, but it may be too technical for the general reader.

JANE WILLOCK RSCN, RN

Senior Sister

University Hospital of Wales1

Philosophical and Theoretical Perspectives for Advanced

Nursing Practice by Janet W. Kenney. 1996. Jones & Bartlett,

London. Pp. 392. ISBN 08672073532 . Price 35.

Advanced nursing practice opportunities continue to grow

throughout the 1990s. Having a resource such as this book

available for nurse educators and clinicians preparing for such roles

is invaluable.

Kenney states in her preface that the need for the book arose from

her work as a teacher of nursing theory. She goes on to state, `rather

than focusing on analysis of nurse theorists' models and theories, it

seems more relevant to assist future advanced nurse practitioners to

understand how nursing is evolving in to a human science, how to

practice theory-based nursing and continue to advance nursing

science'.

The book is a collection of 37 `classic' papers written by largely

American nurse scholars. It is logically organized into nine sections

and follows the arguments and key debates in the history and

evolution of nursing as a human science. Sections I through III

present information on ways of knowing and the challenge to the

natural science paradigm in nursing. Sections IV through VII focus

on describing and explaining the four metaparadigm concepts of

nursing, person, environment, health and nursing. In section VIII,

attention is given to the interrelationship between nursing theory,

practice and research. Section IX is devoted to exploring the

insights into the challenges and opportunities of guiding advanced

nursing practice from a human science perspective. This section

afrms the belief of the reviewer that advanced nursing practice

needs to be guided by the human science paradigm for the future

development of nursing science.

In reviewing this book several questions have arisen. I offer these

few thoughts as a way of continuing the debate about advanced

nursing practice.

Nursing theory holds an invidious position in our professional

history reviled and ignored by most clinical nurses and completely

unknown to patients and their families. Many sources continue to

inform us that nursing is nothing more than `skilled craftsmanship'.

Creation and appreciation of nursing knowledge requires us to be

open to different ways of knowing. As we prepare to enter the new

millennium, are we as a discipline ready to claim nursing as a

signicant contributor to the health debate or are we simply to

accept our heritage as the `doctors handmaiden'?

A clear understanding of the focus and purpose of the discipline

and practice of nursing as a human science is essential for the design

of nursing curricula. A focus on the human sciences helps guide the

integration of multiple ways of knowing in advanced nursing

practice. The essential question is: based on this unique focus for

nursing, what courses and learning experiences are foundational and

complimentary to the study and practice of advanced nursing?

Perhaps it would be remiss of me if I failed to point out that

American nursing scholars author the papers that make up this

book. As such they provide one view of the arguments, and it is

incumbent upon all nurses to contribute to the debate especially

those noted British nurse scholars.

The book is a valuable contribution to the synthesis of the

historical evolution of the human science perspective for advanced

nursing practice. It will prove invaluable to undergraduate and

Journal of Clinical Nursing 1999; 8: 483484

1999 Blackwell Science Ltd 483

graduate students of nursing as well as those who currently practice

in an advanced practice role.

BRIAN MILLAR RN, DN, MN, PGCE

Lecture in Nursing

School of Nursing Studies

University of Wales College of Medicine

EMPOWER by Robert S. Gold, Lawrence W. Green and Marshall

W. Kreuter. 1998. Jones and Bartlett, London. ISBN 0-7637-0410-

5.3

EMPOWER is an acronym for health promotion software entitled

`enabling methods of planning and organising within everyone's

reach'. The EMPOWER programme is accompanied by a manual

and these together provide a step-by-step approach to promote early

detection of breast cancer in primary care by aiming to increase

uptake of mammography and clinical breast examination in a local

population. The change pathway is based on a model that has been

developed over 25 years by public health professionals in the USA

and Canada, and an impressive reference list is included to

substantiate extensive testing and verication of the model used

(the PRECEDEPROCEED model). The programme is aimed at

`small groups' of health professionals with a breast cancer preven-

tion/control remit and, in the UK, one immediately thinks of

primary care groups.

I found the programme and the accompanying manual `user-

friendly', although a prior knowledge of Windows is assumed.

There is easy access to `pull down' menus on every window which

enables the user to run a tutorial, store data or access other les.

Like all programmes, as a rst-time user, I was painstakingly slow.

The programme is organized into six `modules', which in total

enable planning, implementation and evaluation of the breast cancer

control initiative. The modules take the user group through

situational analysis (`where we are now'), social analysis of their

target population, epidemiological analysis of the population,

behavioural and environmental issues affecting uptake of screening,

educational and organizational objectives, and understanding the

administrative and policy context of cancer screening. The detail is

impressive, for example guides to planning meetings (including who

to invite) at key stages in the process are provided. Budget details

are included at each stage (including a facility for zero budgets).

Also, the programme suggests responses based on the views of

expert panels, which can be modied by the planning group, for

example, a vision statement and educational objectives are offered.

The EMPOWER programme then provides summary reports and

agendas at the end of each module based on the information that has

been logged in by the planning group.

Although straightforward enough to be used by any health

professional, the programme asks for some detail in terms of

epidemiological, social and policy input, therefore it would clearly

be a major advantage to have an experienced health planner as part

of any planning group. The data gathering alone could be quite

daunting for an inexperienced group. There is a certain level of

`planning speak' in the programme, such as `stakeholders', `pro-

gramme advocates', `delimiting factors', although there is a

comprehensive glossary provided in the manual. There is also an

e-mail address provided for technical support.

The chief aim of this programme is to reduce deaths from breast

cancer by increasing the uptake of screening (mammography and

clinical breast examination). The authors support this view with an

underpinning theory of health promotion and an impressive list of

published research in the health promotion arena. However, there is

a clear use for software of this nature as an educational tool for

health promotion and cancer care courses, particularly at graduate

and post-graduate level. I would heartily recommend a programme

of this nature for clinical nurse specialists or senior nurses engaged

in higher education as an example of the comprehensive manage-

ment of a health promotion initiative.

Familiarization with such software within educational pro-

grammes for senior nurses and other health professionals would

make adoption into practice initiatives much more likely to

succeed.

ANNE GOUGH RN, MSc

Senior Lecturer

University of Glamorgan

484 Book reviews

1999 Blackwell Science Ltd, Journal of Clinical Nursing, 8, 483484